The Efficacy of Percutaneous Transhepatic Gallbladder Drainage on Acute Cholecystitis in High-Risk Elderly Patients Based on the Tokyo Guidelines

Abstract

To evaluate the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) for high-risk elderly patients with acute cholecystitis.Retrospective analysis of 159 acute cholecystitis patients who were admitted to General Surgery Division III of the First Affiliated Hospital of Dalian Medical University between January 2005 and November 2012. A total of 123 patients underwent laparoscopic cholecystectomy (LC), and 36 received only PTGD treatment. The LC patients were divided into 3 groups based on their preoperative treatment: group A, emergency patients (33 patients); group B (26 patients), patients who were treated with PTGD prior to LC; and group C (64 patients), patients who received nonsurgical treatment prior to LC. General conditions, LC surgery duration, intraoperative blood loss, rate of conversion to open surgery, incidence of postoperative complications, total fasting time, and total hospitalization time were analyzed and compared among the 3 groups.The remission rates of patients in the PTGD treatment groups (including group B and PTGD treatment only group) were significantly higher within 24 and 48 hours than those of patients who received nonsurgical treatment prior to LC (P < 0.05). Among the patients in the 3 surgery groups, the operation conversion rate (19.2%) of group B was significantly higher than that of group A (3.0%) and group C (1.6%) (P < 0.05). The total hospitalization time of the patients in group B (18.5 ± 4.5 days) was longer than that of the patients in group A (8.2 ± 3.9 days) and group C (10.5 ± 6.4 days). The total fasting time of the patients in group A (2.4 ± 1.2 days) was significantly shorter than that of those in group B (4.1 ± 1.7 days) and group C (3.4 ± 2.7 days) (P < 0.05).For high-risk elderly patients, if there is any emergency surgery contraindication, PTGD therapy may be safe and effective and can relieve the symptoms within a short time. For acute cholecystitis patients without surgery contraindications, emergency surgery should be performed as soon as possible after diagnosis.

Emergency general surgery in the geriatric patient

“…For example, in acute cholecystitis, urgent cholecystectomy may still be the preferred choice even in elderly patients. However, percutaneous drainage may be just as efficient in relieving symptoms in the high‐risk elderly patient, and may represent a definite treatment.…”

Clinical Safety of Laparoscopic Cholecystectomy in Elderly Patients: A Comparison of Clinical Outcomes in Patients Aged 65 to 79 Years and over 80 Years

“…In addition, the differences in the overall health status and the incidence of accompanying diseases which were age related were not considered. Furthermore, cases of subtotal cholecystectomy or percutaneous drainage alone, which can be easily and safely applied to manage severe inflammatory AC were excluded [17].…”

Ísetning á kera við gallblöðrubólgu á Landspítala 2010-2016

“…Gallblöðrutaka er framkvaemd 6-8 vikum síðar ef ábending er fyrir því og sjúklingur talinn þola valaðgerð. 4,7,8 Samkvaemt nýju meðferðarleiðbeiningunum er nú maelt með að setja gallblöðrukera fljótt eftir greiningu hjá þeim sem eru með umtalsverða bólgu og/eða er ekki treyst í skurðaðgerð. 2 Gallblöðrukeri er oftast lagður í staðdeyfingu með aðstoð ómunar eða tölvusneiðmyndar og er inngripið oftast framkvaemt af sérfraeðilaekni á röntgendeild.…”